INTRODUCTION:
Lyme disease is caused by an infection with Borrelia burgdorferi sensu latu (B. burgdorferi sl.) which is carried by Ixodes ticks. The disease has not been considered to be endemic in Iceland and no cases of Icelandic origin have been published. The epidemiology of Lyme disease in Iceland has never been studied. The objective of this study was to provide basic epidemiological information about Lyme disease in Iceland.

MATERIAL AND METHODS:
Included in the study were all pa--tients who had a measurement of serum antibodies against B. burgdorferi sl. or were diagnosed with Lyme disease (ICD-10, A69.2) at Landspítali University Hospital in Iceland from 2011-2015. Clinical data regarding these patients was retrospectively collected from medical records and the database of the Department of clinical microbiology at Landspítali University Hospital.

RESULTS:
501 patient had a measurement of serum antibodies against B. burgdorferi sl. and 11 patients were clinically diag-nosed with Lyme disease during the study period. 33 patients fulfilled criteria for a confirmed diagnosis of Lyme disease. 32 (97%) patients had erythema migrans and one (3%) patient had neuroborreliosis. An average of 6.6 cases were diagnosed a year (two cases per 100,000 persons/year). All cases originated abroad.

CONCLUSIONS:Lyme disease is rare in Iceland. On average around 6 to 7 cases are diagnosed every year, primarily localised infec-tions presenting as erythema migrans. None of the cases had a definitive Icelandic origin and the yearly number of cases has not been increasing.

Patients with symptoms persisting six months following a brief antibiotic course should be referred to as having “chronic Lyme disease,” “late Lyme disease,” or “late/chronic Lyme disease” to avoid clinical harm caused to patients when research disease definitions are conflated with clinical care criteria.

Importantly, the existence of late Lyme disease is approved by all official guidelines in the U.S., Canada and Europe. The terms “late” and “chronic” Lyme disease, as in syphilis, are synonymous and define tertiary Lyme disease [20, 125]. The use of “chronic” Lyme disease as a different entity is inaccurate and confusing.

ILADS’ perspective on the NIH’s strategic plan for tickborne diseases research is important to consider because ILADS is the only multi-specialty medical society in the U.S. that is dedicated to the appropriate diagnosis and treatment of all forms of Lyme disease (including chronic Lyme disease) and associated TBDs. ILADS members care for patients with complex cases of Lyme disease which are often complicated by concurrent tickborne infections. The collective experience and insights of these clinicians are valuable and need to be considered.

Patients who are suing over alleged denial of care for long-standing Lyme disease may have to submit to medical examination to prove their conditions, a federal judge ruled in a hearing in Texarkana, Texas, federal court.

This study concluded No effect of rituximab treatment in patients with ME/CFS but one of the exclusion criteria was 'Evidence of ongoing, active and clinically relevant infection (1)'. Patients with evidence of active ongoing infections were left out of the study. Many studies show a strong association between ongoing infection and CFS (2). Wiping out damaged B-cells allows the body to replace them with healthy B-cells which can do a better job fighting the ongoing infections.https://kavlifondet.no/en/2019/04/no-ef ... th-me-cfs/

Abstract
PURPOSE OF REVIEW:
To review the recent evidence clarifying the symptomatology and diagnosis of nervous system Lyme disease.

RECENT FINDINGS:
Two-tier testing combining pairs of ELISAs, using C6 or VlsE assays to replace second tier Western blots, may eliminate confusion about test interpretation. Cerebrospinal fluid (CSF) can be informative in diagnosing central nervous system (CNS) Lyme disease, not peripheral nervous system (PNS) disorders. CSF CXCL13 may provide useful adjunctive information in CNS infection; its specificity remains to be defined. Lyme encephalopathy is not indicative of CNS infection. Post treatment Lyme disease symptoms do not occur in patients who have had definite CNS Lyme infection. Whether post treatment Lyme disease symptom (PTLDS) is an actual entity, or reflects anchoring bias when commonly occurring symptoms arise in patients previously treated for Lyme disease, remains to be determined. Regardless, these symptoms do not reflect CNS infection and do not respond to additional antimicrobial therapy.

SUMMARY:
Serologic testing is robust in individuals with a priori likelihood of infection of greater than 2-6 weeks duration. Western blots provide useful confirmation of screening ELISAs, but may be replaced by second ELISAs. CSF testing, including CXCL13, may be informative in CNS Lyme, not PNS, and is generally normal in Lyme encephalopathy. PTLDS does not occur following CNS infection, and may not be a distinct entity.